Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry

Joo Myung Lee; Jeehoon Kang; Euijae Lee; Doyeon Hwang; Tae Min Rhee; Jonghanne Park; Hack Lyoung Kim; Sang Eun Lee; Jung Kyu Han; Han Mo Yang; Kyung Woo Park; Sang Hoon Na; Hyun Jae Kang; Bon Kwon Koo; Hyo Soo Kim

doi:10.1016/j.jcin.2016.06.051

Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry

Joo Myung Lee
, Jeehoon Kang
, Euijae Lee
, Doyeon Hwang
, Tae Min Rhee
, Jonghanne Park
, Hack Lyoung Kim
, Sang Eun Lee
, Jung Kyu Han
, Han Mo Yang
, Kyung Woo Park
, Sang Hoon Na
, Hyun Jae Kang
, Bon Kwon Koo
, Hyo Soo Kim

Department of Internal Medicine

Seoul National University

Research output: Contribution to journal › Article › peer-review

66 Scopus citations

Abstract

Objectives The purpose of this study was to evaluate the clinical impact of chronic kidney disease (CKD) on clinical outcomes in contemporary practice of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES). Background Although second-generation DES have improved the safety and efficacy issues in PCI, data regarding the performance of second-generation DES in patients with CKD are still limited. Methods We performed a patient-level pooled analysis on 12,426 patients undergoing PCI using second-generation DES from the Korean Multicenter Drug-Eluting Stent Registry. Endpoints were stent-oriented outcomes (target lesion failure [TLF]) and patient-oriented composite outcomes (POCO) during a median follow-up of 35 months. CKD patients were stratified by the estimated glomerular filtration rate (eGFR) from mild CKD to end-stage renal disease patients, and by the coexistence of diabetes mellitus (DM). Results A total of 2,927 patients had CKD (23.6%), who showed a significantly higher risk of TLF (adjusted hazard ratio [HR_adjust]: 1.50; 95% confidence interval [CI]: 1.21 to 1.86) and POCO (HR_adjust 1.34; 95% CI: 1.17 to 1.55) compared to patients with preserved renal function. Stratified analysis by eGFR showed that TLF was not increased in the mild to moderate CKD, whereas severe CKD and dialysis-dependent patients showed significantly higher risk of TLF (HR_adjust 2.44; 95% CI: 1.54 to 3.86; HR_adjust 3.58; 95% CI: 2.52 to 5.08, respectively). The eGFR threshold of increased clinical events was 40 to 45 ml/min/1.73 m². Among CKD patients, DM CKD patients showed a higher incidence of TLF compared to non-DM CKD patients (HR_adjust: 1.82; 95% CI: 1.32 to 2.52), driven by the increase in target vessel–related events. Conclusions In the era of second-generation DES, CKD patients were at a significantly higher risk of clinical outcomes only in severe CKD and end-stage renal disease patients.

Original language	English
Pages (from-to)	2097-2109
Number of pages	13
Journal	JACC: Cardiovascular Interventions
Volume	9
Issue number	20
DOIs	https://doi.org/10.1016/j.jcin.2016.06.051
State	Published - 24 Oct 2016

Keywords

chronic kidney disease
chronic renal failure
clinical outcomes
coronary artery disease
drug-eluting stent(s)
percutaneous coronary intervention

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jcin.2016.06.051

Cite this

Lee, J. M., Kang, J., Lee, E., Hwang, D., Rhee, T. M., Park, J., Kim, H. L., Lee, S. E., Han, J. K., Yang, H. M., Park, K. W., Na, S. H., Kang, H. J., Koo, B. K., & Kim, H. S. (2016). Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry. JACC: Cardiovascular Interventions, 9(20), 2097-2109. https://doi.org/10.1016/j.jcin.2016.06.051

@article{e85112a54d594b468e400fe3c38383c9,

title = "Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry",

abstract = "Objectives The purpose of this study was to evaluate the clinical impact of chronic kidney disease (CKD) on clinical outcomes in contemporary practice of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES). Background Although second-generation DES have improved the safety and efficacy issues in PCI, data regarding the performance of second-generation DES in patients with CKD are still limited. Methods We performed a patient-level pooled analysis on 12,426 patients undergoing PCI using second-generation DES from the Korean Multicenter Drug-Eluting Stent Registry. Endpoints were stent-oriented outcomes (target lesion failure [TLF]) and patient-oriented composite outcomes (POCO) during a median follow-up of 35 months. CKD patients were stratified by the estimated glomerular filtration rate (eGFR) from mild CKD to end-stage renal disease patients, and by the coexistence of diabetes mellitus (DM). Results A total of 2,927 patients had CKD (23.6\%), who showed a significantly higher risk of TLF (adjusted hazard ratio [HRadjust]: 1.50; 95\% confidence interval [CI]: 1.21 to 1.86) and POCO (HRadjust 1.34; 95\% CI: 1.17 to 1.55) compared to patients with preserved renal function. Stratified analysis by eGFR showed that TLF was not increased in the mild to moderate CKD, whereas severe CKD and dialysis-dependent patients showed significantly higher risk of TLF (HRadjust 2.44; 95\% CI: 1.54 to 3.86; HRadjust 3.58; 95\% CI: 2.52 to 5.08, respectively). The eGFR threshold of increased clinical events was 40 to 45 ml/min/1.73 m2. Among CKD patients, DM CKD patients showed a higher incidence of TLF compared to non-DM CKD patients (HRadjust: 1.82; 95\% CI: 1.32 to 2.52), driven by the increase in target vessel–related events. Conclusions In the era of second-generation DES, CKD patients were at a significantly higher risk of clinical outcomes only in severe CKD and end-stage renal disease patients.",

keywords = "chronic kidney disease, chronic renal failure, clinical outcomes, coronary artery disease, drug-eluting stent(s), percutaneous coronary intervention",

author = "Lee, \{Joo Myung\} and Jeehoon Kang and Euijae Lee and Doyeon Hwang and Rhee, \{Tae Min\} and Jonghanne Park and Kim, \{Hack Lyoung\} and Lee, \{Sang Eun\} and Han, \{Jung Kyu\} and Yang, \{Han Mo\} and Park, \{Kyung Woo\} and Na, \{Sang Hoon\} and Kang, \{Hyun Jae\} and Koo, \{Bon Kwon\} and Kim, \{Hyo Soo\}",

note = "Publisher Copyright: {\textcopyright} 2016 American College of Cardiology Foundation",

year = "2016",

month = oct,

day = "24",

doi = "10.1016/j.jcin.2016.06.051",

language = "English",

volume = "9",

pages = "2097--2109",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "20",

}

Lee, JM, Kang, J, Lee, E, Hwang, D, Rhee, TM, Park, J, Kim, HL, Lee, SE, Han, JK, Yang, HM, Park, KW, Na, SH, Kang, HJ, Koo, BK & Kim, HS 2016, 'Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry', JACC: Cardiovascular Interventions, vol. 9, no. 20, pp. 2097-2109. https://doi.org/10.1016/j.jcin.2016.06.051

TY - JOUR

T1 - Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era

T2 - Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry

AU - Lee, Joo Myung

AU - Kang, Jeehoon

AU - Lee, Euijae

AU - Hwang, Doyeon

AU - Rhee, Tae Min

AU - Park, Jonghanne

AU - Kim, Hack Lyoung

AU - Lee, Sang Eun

AU - Han, Jung Kyu

AU - Yang, Han Mo

AU - Park, Kyung Woo

AU - Na, Sang Hoon

AU - Kang, Hyun Jae

AU - Koo, Bon Kwon

AU - Kim, Hyo Soo

PY - 2016/10/24

Y1 - 2016/10/24

N2 - Objectives The purpose of this study was to evaluate the clinical impact of chronic kidney disease (CKD) on clinical outcomes in contemporary practice of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES). Background Although second-generation DES have improved the safety and efficacy issues in PCI, data regarding the performance of second-generation DES in patients with CKD are still limited. Methods We performed a patient-level pooled analysis on 12,426 patients undergoing PCI using second-generation DES from the Korean Multicenter Drug-Eluting Stent Registry. Endpoints were stent-oriented outcomes (target lesion failure [TLF]) and patient-oriented composite outcomes (POCO) during a median follow-up of 35 months. CKD patients were stratified by the estimated glomerular filtration rate (eGFR) from mild CKD to end-stage renal disease patients, and by the coexistence of diabetes mellitus (DM). Results A total of 2,927 patients had CKD (23.6%), who showed a significantly higher risk of TLF (adjusted hazard ratio [HRadjust]: 1.50; 95% confidence interval [CI]: 1.21 to 1.86) and POCO (HRadjust 1.34; 95% CI: 1.17 to 1.55) compared to patients with preserved renal function. Stratified analysis by eGFR showed that TLF was not increased in the mild to moderate CKD, whereas severe CKD and dialysis-dependent patients showed significantly higher risk of TLF (HRadjust 2.44; 95% CI: 1.54 to 3.86; HRadjust 3.58; 95% CI: 2.52 to 5.08, respectively). The eGFR threshold of increased clinical events was 40 to 45 ml/min/1.73 m2. Among CKD patients, DM CKD patients showed a higher incidence of TLF compared to non-DM CKD patients (HRadjust: 1.82; 95% CI: 1.32 to 2.52), driven by the increase in target vessel–related events. Conclusions In the era of second-generation DES, CKD patients were at a significantly higher risk of clinical outcomes only in severe CKD and end-stage renal disease patients.

AB - Objectives The purpose of this study was to evaluate the clinical impact of chronic kidney disease (CKD) on clinical outcomes in contemporary practice of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES). Background Although second-generation DES have improved the safety and efficacy issues in PCI, data regarding the performance of second-generation DES in patients with CKD are still limited. Methods We performed a patient-level pooled analysis on 12,426 patients undergoing PCI using second-generation DES from the Korean Multicenter Drug-Eluting Stent Registry. Endpoints were stent-oriented outcomes (target lesion failure [TLF]) and patient-oriented composite outcomes (POCO) during a median follow-up of 35 months. CKD patients were stratified by the estimated glomerular filtration rate (eGFR) from mild CKD to end-stage renal disease patients, and by the coexistence of diabetes mellitus (DM). Results A total of 2,927 patients had CKD (23.6%), who showed a significantly higher risk of TLF (adjusted hazard ratio [HRadjust]: 1.50; 95% confidence interval [CI]: 1.21 to 1.86) and POCO (HRadjust 1.34; 95% CI: 1.17 to 1.55) compared to patients with preserved renal function. Stratified analysis by eGFR showed that TLF was not increased in the mild to moderate CKD, whereas severe CKD and dialysis-dependent patients showed significantly higher risk of TLF (HRadjust 2.44; 95% CI: 1.54 to 3.86; HRadjust 3.58; 95% CI: 2.52 to 5.08, respectively). The eGFR threshold of increased clinical events was 40 to 45 ml/min/1.73 m2. Among CKD patients, DM CKD patients showed a higher incidence of TLF compared to non-DM CKD patients (HRadjust: 1.82; 95% CI: 1.32 to 2.52), driven by the increase in target vessel–related events. Conclusions In the era of second-generation DES, CKD patients were at a significantly higher risk of clinical outcomes only in severe CKD and end-stage renal disease patients.

KW - chronic kidney disease

KW - chronic renal failure

KW - clinical outcomes

KW - coronary artery disease

KW - drug-eluting stent(s)

KW - percutaneous coronary intervention

UR - https://www.scopus.com/pages/publications/84992734310

U2 - 10.1016/j.jcin.2016.06.051

DO - 10.1016/j.jcin.2016.06.051

M3 - Article

C2 - 27692820

AN - SCOPUS:84992734310

SN - 1936-8798

VL - 9

SP - 2097

EP - 2109

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 20

ER -